D is for Disability (part 2 of 2)

20 October, 2010 by: colinparker

Severe Head Injury: is any treatment proven to work? Join us as we explore the literature behind currently accepted treatments for serious traumatic brain injury, in particular the role for therapeutic hypothermia.

Of all the things we do in the ED for severely head-injured children in the acute phase, the most important are probably to maintain oxygenation and perfusion of the brain. The evidence base supporting other interventions is less clear, but these may still make sense from a pathophysiologic perspective. Therapeutic hypothermia, in various forms, has been studied by a number of groups. Sit back and relax, while we talk you through it…

Walker 2009

TBI-Hypothermia Papers

Let’s go back in time, to when it all started… Then we’ll skip forward to the last decade or so.

Hendrick 1959

The use of hypothermia in severe head injuries in childhood. E Bruce Hendrick.Archives of Surgery 1959; 79: 362-364
Beneficial effects of reducing body temperature on the brain, decreased cerebral oedema and increased ability to resist hypoxia

Hutchison 2008

Taylor 2001

A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Taylor A, et al.Child’s Nervous System 2001; 17: 154-162
Authors include Frank Shann & Jim Tibballs
RCT of early (19hrs median, 7-29hrs) decompressive craniectomy
Graph very illustrative of better ICP profiles
2/14 controls had good outcome (normal or mild disability) at 6 months
7/13 in decompression group
p=0.046, NS because of multiple peeks near end of study (required p of <0.02)
Therefore labelled a pilot study…

Summary

That’s all Folks!
Expect to hear from us again in 2 weeks, and as always, feel free to share your thoughts via the comments box below…